MEDICARE: KARAN ANN KORTLANDER N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	95013412	CA

General Provider Information

NPI Number	:	1174163703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARAN ANN KORTLANDER N.P.

Provider Business Mailing Address
First Line	:	11633 SAN VICENTE BLVD STE 230
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-6513
Country	:	US
Telephone Number	:	310-826-3376
Fax Number	:	310-826-3370

Provider Business Practice Location Address
First Line	:	2284 E MAPLE AVE
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-6507
Country	:	US
Telephone Number	:	818-468-1806
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2020
Last Update Date	:	01/19/2020

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